100+ Free ABIM Sleep Medicine Practice Questions

Pass your ABIM Sleep Medicine Subspecialty Certification exam on the first try — instant access, no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

85% Pass Rate

100+ Questions

100% Free

1 / 10

Question 1

Score: 0/0

Which NREM sleep stage is characterized by slow-wave activity occupying at least 20% of the epoch?

REM

to track

2026 Statistics

Key Facts: ABIM Sleep Medicine Exam

~220

Total Exam Questions

ABIM subspecialty exam format

~$2,990

2026 ABIM Subspecialty Fee

ABIM exam information page

≥15

AHI for Moderate OSA

AASM severity criteria

≤8 min

MSLT MSL Cutoff

ICSD-3 narcolepsy diagnostic criteria

<110 pg/mL

CSF Hypocretin for Narcolepsy Type 1

ICSD-3

≥4h × 70%

CMS PAP Adherence Rule

CMS PAP coverage policy

Internal medicine-trained sleep physicians sit a single multi-board Sleep Medicine exam administered by ABIM. Current format is approximately 220 multiple-choice questions delivered as 4 modules, criterion-referenced pass/fail scoring, with a 2026 ABIM subspecialty application + exam fee near $2,990. Content emphasizes AASM 2023 scoring, OSA/CSA management (including SERVE-HF guidance), narcolepsy diagnosis, DORAs for insomnia, and sleep-disordered breathing in IM comorbidities.

Sample ABIM Sleep Medicine Practice Questions

Try these sample questions to test your ABIM Sleep Medicine exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which NREM sleep stage is characterized by slow-wave activity occupying at least 20% of the epoch?

A.N1

B.N2

C.N3

D.REM

Explanation: Per AASM 2023 scoring rules, N3 (slow-wave sleep) is scored when ≥20% of an epoch contains slow-wave activity (0.5-2 Hz, ≥75 µV peak-to-peak) recorded over the frontal derivations. N3 replaces the older Stages 3 and 4 classification. In young adults N3 comprises ~13-23% of total sleep time and concentrates in the first third of the night.

2The suprachiasmatic nucleus (SCN) synchronizes the endogenous circadian rhythm primarily through which input?

A.Auditory input from the cochlear nerve

B.Photic input via the retinohypothalamic tract

C.Olfactory input from the olfactory bulb

D.Thermal input from peripheral receptors

Explanation: The SCN in the anterior hypothalamus receives light information from intrinsically photosensitive retinal ganglion cells (ipRGCs, melanopsin-containing) via the retinohypothalamic tract. This photic signal entrains the ~24.2-hour endogenous rhythm to the external light-dark cycle and modulates melatonin secretion via the pineal gland through a polysynaptic pathway.

3According to Borbély's two-process model of sleep regulation, 'Process S' represents which component?

A.The circadian process driven by the SCN

B.Homeostatic sleep pressure accumulating with wakefulness

C.The ultradian REM/NREM alternation

D.The thermoregulatory drop associated with sleep onset

Explanation: In Borbély's two-process model, Process S is the homeostatic sleep drive that rises during wakefulness (reflected in slow-wave activity on EEG) and dissipates exponentially during sleep. Process C is the circadian alerting signal generated by the SCN. The interaction of S and C determines sleep propensity and timing.

4How long is a typical NREM-REM sleep cycle in adults?

A.30 minutes

B.60 minutes

C.90 minutes

D.120 minutes

Explanation: A typical adult NREM-REM cycle is approximately 90 minutes (range 70-120 min). Early-night cycles are dominated by N3, while REM periods lengthen across the night so that the majority of REM sleep occurs in the final third — a pattern important for interpreting REM-related sleep-disordered breathing.

5Which EEG waveforms are the defining hallmarks of stage N2 sleep?

A.Alpha rhythm and vertex waves

B.K complexes and sleep spindles

C.Sawtooth waves and low-voltage mixed frequency activity

D.Slow waves ≥75 µV

Explanation: Stage N2 is defined by K complexes (well-delineated negative sharp wave followed by a positive component, ≥0.5 sec) and/or sleep spindles (11-16 Hz, usually 12-14 Hz, ≥0.5 sec). These waveforms are generated by thalamocortical oscillators and occupy the largest fraction of adult sleep (45-55% of total sleep time).

6The recommended EEG derivations per the AASM 2023 scoring manual are F4-M1, C4-M1, and O2-M1. What is the purpose of using the contralateral mastoid reference (M1)?

A.To reduce 60-Hz line noise

B.To provide a relatively inactive reference outside the dominant scalp electrical field

C.To capture cardiac artifact for ECG scoring

D.To allow simultaneous EOG recording

Explanation: AASM recommends referencing each scalp electrode to the contralateral mastoid (M1 or M2) because the mastoid is relatively electrically inactive, which improves signal-to-noise and minimizes contamination from adjacent cortical activity. Backup derivations F3-M2, C3-M2, O1-M2 are used when the primary electrodes fail.

7Per AASM 2023 rules, airflow for apnea identification is measured using which primary sensor?

A.Nasal pressure transducer

B.Oronasal thermal sensor (thermistor)

C.End-tidal CO2

D.Respiratory inductance plethysmography

Explanation: AASM specifies an oronasal thermal sensor (thermistor or thermocouple) as the recommended sensor to identify apneas because it detects temperature change regardless of mouth vs nasal breathing. A nasal pressure transducer is the recommended sensor for hypopneas because it is more amplitude-sensitive to small flow reductions.

8A 52-year-old internal medicine clinic patient has an apnea-hypopnea index (AHI) of 22/hour with daytime sleepiness and hypertension. By AASM severity criteria, his OSA is best classified as:

A.Normal variant

B.Mild

C.Moderate

D.Severe

Explanation: AASM severity cutoffs for OSA are mild (AHI 5-14), moderate (15-29), and severe (≥30). AHI 22/hr with symptoms places this patient in the moderate category and supports initiating PAP therapy, with blood pressure improvement as a likely secondary benefit in this hypertensive patient.

9Which CMS criterion defines adequate PAP adherence for continued CPAP coverage in OSA?

A.PAP use ≥2 hours per night on 50% of nights

B.PAP use ≥4 hours per night on ≥70% of nights over a 30-day period within the first 90 days

C.Any use averaging 3 hours per night

D.AHI on PAP <10 regardless of hours used

Explanation: For Medicare coverage beyond the 90-day trial, PAP adherence is defined as use ≥4 hours per night on ≥70% of nights during a consecutive 30-day period within the first 3 months, with documented clinical benefit during face-to-face reevaluation. Private payers typically mirror this rule.

10A 62-year-old internal medicine patient with HFrEF and LVEF of 35% has predominantly central apneas with Cheyne-Stokes respiration on a diagnostic PSG. Which therapy is contraindicated based on the SERVE-HF trial?

A.CPAP

B.Supplemental oxygen

C.Adaptive servo-ventilation (ASV)

D.Positional therapy

Explanation: The SERVE-HF trial (2015) demonstrated increased all-cause and cardiovascular mortality with ASV in patients with symptomatic HFrEF and LVEF ≤45% and predominantly central sleep apnea. ASV is therefore contraindicated in this population; alternatives include CPAP, nocturnal oxygen, or optimizing guideline-directed medical therapy for HF.

About the ABIM Sleep Medicine Exam

The ABIM Sleep Medicine Subspecialty exam is the internal medicine pathway into the single multi-board Sleep Medicine exam co-sponsored by ABIM, ABA, ABFM, ABPN, ABOHNS, and ABP and administered by ABIM. It verifies expertise in polysomnography interpretation, sleep-related breathing disorders, hypersomnia, insomnia, circadian disorders, parasomnias, and sleep-disordered breathing in internal medicine comorbidities (HF, COPD, ESRD, stroke, pregnancy).

Questions

220 scored questions

Time Limit

About 10 hours across 4 modules

Passing Score

Criterion-referenced scaled score set by ABIM (pass/fail)

Exam Fee

~$2,990 application + exam fee (ABIM 2026) (ABIM (administering jointly on behalf of ABA, ABFM, ABPN, ABOHNS, and ABP))

ABIM Sleep Medicine Exam Content Outline

30-35%

Sleep-Related Breathing Disorders

OSA severity, PAP titration, CPAP adherence (CMS ≥4 hr × 70% of nights), OHS (PaCO2 ≥45 mm Hg awake), central apnea (Cheyne-Stokes in HFrEF, opioid-induced, treatment-emergent), SERVE-HF ASV contraindication at LVEF ≤45%, hypoglossal nerve stimulation, pediatric OSA

15-20%

Polysomnography, HSAT & Scoring

AASM 2023 rules, EEG (F4-M1/C4-M1/O2-M1) and EOG/chin EMG, respiratory sensors (thermistor for apnea, nasal pressure for hypopnea), RIP belts, arousal criteria, HSAT Type III, split-night, pediatric scoring

10-15%

Normal Sleep & Physiology

NREM/REM architecture, 90-min cycle, two-process model (Borbély), SCN via retinohypothalamic tract, melatonin and CBT nadir, sleep-wake neurochemistry, lifespan changes

10-15%

Central Disorders of Hypersomnolence

Narcolepsy type 1/2, idiopathic hypersomnia (low-sodium oxybate FDA 2021), Kleine-Levin, MSLT/MWT interpretation, CSF hypocretin <110 pg/mL, pharmacology (pitolisant, solriamfetol, oxybate)

10-15%

Insomnia

Chronic insomnia disorder, CBT-I first-line (AASM/ACP), DORAs (suvorexant, lemborexant, daridorexant) preferred 2022 ACP, doxepin 3-6 mg, ramelteon, Z-drug FDA black box 2019

10-15%

Parasomnias & Movement Disorders

RBD (synuclein prodrome, melatonin/clonazepam, RSWA), NREM parasomnias from N3 early-night, RLS/WED (alpha-2-delta ligands first-line 2020 AASM update, ferritin >75-100), PLMS, SRED

5-10%

Circadian Rhythm Sleep-Wake Disorders

DSPD (melatonin 0.5 mg before DLMO), ASPD, shift work, jet lag, non-24 in blind (tasimelteon), DLMO phase assessment, irregular sleep-wake

5-10%

Sleep in IM Comorbidities

Sleep-disordered breathing in HF, COPD overlap (nocturnal oxygen <88%), ESRD/uremic RLS, post-stroke SDB, AF/HTN associations, gestational OSA, IM pharmacology effects on sleep

How to Pass the ABIM Sleep Medicine Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABIM (pass/fail)
Exam length: 220 questions
Time limit: About 10 hours across 4 modules
Exam fee: ~$2,990 application + exam fee (ABIM 2026)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABIM Sleep Medicine Study Tips from Top Performers

1Memorize AASM 2023 respiratory event thresholds exactly: apnea ≥90% airflow drop for ≥10s (thermistor); hypopnea ≥30% drop for ≥10s + 3% desat or arousal (1A) vs 4% desat (1B, CMS)

2Drill MSLT criteria until instant: MSL ≤8 min plus ≥2 SOREMPs supports narcolepsy; a sleep-onset REM on the preceding PSG (within 15 min of sleep onset) counts as one SOREMP

3Lock in SERVE-HF: ASV contraindicated in symptomatic HFrEF with LVEF ≤45%; preserved EF allows ASV for treatment-emergent CSA after CPAP optimization

4For RLS pharmacology, remember the 2020 AASM guideline shift: alpha-2-delta ligands (gabapentin enacarbil, pregabalin) now first-line over dopamine agonists; target ferritin >75-100 ng/mL and watch for augmentation

5For insomnia pharmacology, know the 2022 ACP update favoring DORAs (suvorexant, lemborexant, daridorexant) plus low-dose doxepin 3-6 mg for older adults; Z-drugs carry a 2019 FDA black-box warning for complex sleep behaviors

Frequently Asked Questions

Is ABIM Sleep Medicine a separate exam from the ABA Sleep Medicine exam?

No. The Sleep Medicine subspecialty exam is a single, multi-board exam co-sponsored by ABIM, ABA, ABFM, ABPN, ABOHNS, and ABP and administered by ABIM. Internal medicine candidates register through the ABIM portal but sit the same content-equivalent exam as other specialties.

Who is eligible to sit the ABIM Sleep Medicine exam?

Candidates must hold active ABIM Internal Medicine primary certification and have completed a 12-month ACGME-accredited Sleep Medicine fellowship. Primary certification must be in good standing and the candidate must hold an unrestricted medical license.

How much does the 2026 ABIM Sleep Medicine exam cost?

The ABIM subspecialty application + exam fee is approximately $2,990 for 2026. Fees are set by ABIM and apply to each attempt. Registration is through the ABIM portal and typically opens in December for the following November exam.

How many questions are on the Sleep Medicine exam?

ABIM-administered subspecialty exams typically deliver approximately 220 multiple-choice questions across 4 modules of ~60 questions with scheduled break time between modules, totaling about a 10-hour exam day.

What scoring manual should I study for polysomnography questions?

Use the AASM Manual for the Scoring of Sleep and Associated Events (2023 rules), especially respiratory event thresholds (apnea ≥90% airflow drop for ≥10 s; hypopnea ≥30% drop with 3% desat or arousal per 1A, or 4% desat per 1B), arousal criteria, staging (N1/N2/N3/REM), and pediatric rules.

How is ABIM Sleep Medicine certification maintained?

You can choose a traditional 10-year recertification exam or the Longitudinal Knowledge Assessment (LKA), which delivers about 600 questions over 5 years and requires engagement with at least 500. LKA is the preferred MOC pathway for most ABIM diplomates.

Is adaptive servo-ventilation safe in heart failure with central sleep apnea?

ASV is contraindicated in symptomatic heart failure with reduced ejection fraction (LVEF ≤45%) because of increased mortality in SERVE-HF. In preserved ejection fraction (LVEF >45%), ASV remains a valid option for treatment-emergent CSA after CPAP optimization.

What is the first-line insomnia pharmacotherapy per current guidelines?

CBT-I is first-line per AASM and ACP. When pharmacotherapy is used, the 2022 ACP guideline update endorses DORAs (suvorexant, lemborexant, daridorexant) over Z-drugs due to a favorable safety profile. Low-dose doxepin (3-6 mg) is useful for sleep maintenance in older adults.